Resident Clinical Training

The residents see an average of 90,000 patients per year through the busy clinics at the New York Eye and Ear Infirmary of Mount Sinai (NYEE). The residents have full responsibility for the patients they care for in the clinic under the supervision of dedicated faculty.

First-year residents have exposure to each subspecialty clinic on multiple rotations throughout the year. Second and third year residents have exposure to each subspecialty clinic on block rotations. Inpatient ophthalmology consults are done in the second year at Beth Israel Medical Center.

New York Eye and Ear Infirmary also offers the Urgent Care Clinic and the Metropolitan Eye Trauma Center which is primarily covered by the ophthalmology residents with 24/7 attending backup. Residents have the opportunity to learn about ophthalmic disease and patient care in the emergency and trauma setting.

Resident-run clinics are offered in every subspecialty including:

Ocular Oncology

Residents are trained on the Ocular Oncology Service and become competent in the evaluation and differential diagnosis of ocular tumors. They take responsibility for patients and perform eye cancer surgeries while supervised by Paul T. Finger, MD. Surgical procedures include biopsy techniques, laser photocoagulation, cryotherapy, local resection, orbitotomy, enucleation, orbital exenteration, and ophthalmic plaque radiotherapy.

The Ocular Tumor Service curriculum is organized so that there are three hours of didactic instruction, and attendance at lectures is mandatory. In addition, the diagnosis and treatment of patients often generate spontaneous lectures in the clinical setting. Elements of patient education and informed consent are also discussed.

From their experience, residents are expected to form a differential diagnosis, describe how that diagnosis was made, and suggest methods of treatment. During each clinic session, individual residents are asked questions and an assessment is made about their current knowledge and reading habits. Medical students, fellows, and attending physicians visit our clinic as they express an interest.

Resident research activities in ocular oncology are strongly encouraged. Manuscripts are generated from unusual cases, reviews, and basic science studies. Many investigational protocols are currently active within The Ocular Oncology Service.

Oculoplastic and Orbital

The teaching program in Oculoplastic and Reconstructive Surgery includes formal lectures given during the first six months of each academic year, followed by a comprehensive written examination. Residents from each postgraduate year spend approximately eight weeks on rotation with the Oculoplastic Service. Patients are evaluated with the assistance of the fellow and are then presented to the attending for discussion of appropriate management.

Residents evaluate additional patients presenting with orbital and eyelid trauma and other urgent oculoplastic problems. A rotating schedule of oculoplastic trauma attendings assures that senior staff members are available to assist the residents in all cases that require urgent attention or surgery. Clinic organization allows for continuity of care and an effective academic and surgical experience for the residents. Residents block surgical time every week to perform cases with assigned members of the Oculoplastic Service.

During the clinic sessions, specific cases are chosen for more detailed discussion. On a regular basis, the residents have the opportunity to evaluate and treat the wide range of congenital and acquired eyelid abnormalities, lacrimal (tear duct) problems, periorbital and eyelid tumors, and a significant number of eye socket problems. Systemic illnesses that may affect the orbit including thyroid disease, and infectious and inflammatory diseases of the orbits and tissues around the eyes are seen frequently in our clinics and are treated medically and surgically as indicated.

CT and MRI studies are reviewed weekly or immediately as required. Members of the service have the opportunity to review the histopathology of all surgical cases with the Pathology department. We strongly encourage a multidisciplinary approach and work closely with the Pathology and Radiology departments as well as Neuro-Ophthalmology and Ocular Oncology services. In addition, the relationships with the Medical Oncology and Radiotherapy departments at Beth Israel and St. Luke’s-Roosevelt Hospital Center are very strong. We are confident that the merger of New York Eye and Ear Infirmary into the Mount Sinai Health System will be advantageous.

By the completion of the residents’ rotations, it is expected that the residents will be proficient in nasolacrimal duct probing and intubation, dacryocystorhinostomy, entropion and ectropion repair, eyelid laceration repair, enucleation, evisceration, and ptosis repair. Over the past three decades, 30 national and more than 80 international fellows have trained in our program, many of whom have become leaders as clinicians and teachers, both here and abroad.

Retina

The senior retina resident attends all surgical retina clinics and organizes the surgical schedule in concert with the attendance of the service. Surgery is performed under the direct supervision of an attending surgeon, who makes decisions based on the resident’s ability and the patient’s needs. In addition, the resident is responsible for monitoring all in-house retinal patients, assisting and supervising the junior resident, and is available for retinal consultation on all clinic cases. The senior resident is expected to consult with the Chief of Service on any unusual cases, reoperations, and scheduling problems. The average number of surgical cases done by each senior resident is 12 scleral buckles, 14 vitrectomies, and 4 cryopexies.

Neuro-Ophthalmology

The clinic is always staffed by an attending neuro-ophthalmologist. Residents and fellows evaluate the patients and present them to the clinic. Each patient stimulates discussion concerning the diagnosis, evaluation, and treatment of their illness.

There is a strong interest in neuroradiology and residents are instructed on the evaluation of CT and MR scans. Residents are responsible for the hospitalized patients on the neuro-ophthalmology service at NYEE and on the neurology service at Mount Sinai Beth Israel.

In addition to the educational opportunities centering about the patients, there are formal neuro-ophthalmological lectures as part of the overall educational program and neuro-ophthalmology case study specific Ophthalmology departmental grand rounds presentations.

The curriculum for the neuro-ophthalmology subspecialty training in the residency includes a weekly outpatient neuro-ophthalmology clinic, patients hospitalized from clinic, and daily telephone or in-person consultations of neuro-ophthalmology patients, seen in either clinics or the Emergency Room at New York Eye and Ear Infirmary or Mount Sinai Beth Israel Hospital.

Pediatric Ophthalmology and Strabismus Resident Training

The Resident Training Program benefits from the variety and number of cases. An increasing number of attending physicians have enriched the training with lectures on a wide range of subjects concerning pediatric ophthalmology and strabismus. These lectures have helped prepare the residents for their OKAP examinations as well as for their general training in ophthalmology. Clinical conferences regarding interesting strabismus and pediatric cases are held weekly. Proper evaluation for further medical care or surgery is done with participation of all the residents and attending physicians.

Ophthalmic Pathology Resident Training

Educational outreach is an important goal for the Ophthalmic Pathology Department. Educational relations with other New York Medical College affiliates have resulted in rotations for pathology residents from New York Medical College institutions at NYEE and for ophthalmology residents from our sister program at St. Vincent’s Medical Center. Members of the department continue their provision of pathology education for residents at Cornell University Medical Center and Northshore University Hospital.

Our Cornea and Refractive Surgery residents and attending physicians have access to the latest technologies including corneal topography, WaveScan™ analysis, femtosecond lasers, and excimer laser correction to treat refractive errors. Cornea, External Disease, and Refractive Surgery Clinics are conducted three half-days per week, concurrently with a Contact Lens Clinic. Approximately 2,500 patients are seen per year in the Cornea Clinic and 1,500 patients in the Contact Lens Clinic. Resident clinics and surgery are staffed at all times by an attending physician.

All of our attending staff has completed fellowship training in corneal and refractive surgery. Instruction in the surgical treatment of corneal diseases includes lectures and wet lab courses given in our microsurgical laboratory. Nonemergent corneal surgery is regularly scheduled one day per week. Residents also receive extensive training in laser vision correction, including lectures, and attendance at laser and microkeratome courses throughout the year. Residents will have the opportunity to perform laser vision correction procedures, and can achieve certification in these techniques prior to the end of their residency. The Cornea and Refractive Surgery Service also sponsors a series of 15 one-hour lectures, a series of lectures throughout the academic year covering all areas of the specialty. Following this series of lectures, an examination prepared by the attending staff is administered to each resident and reviewed individually. To help prepare residents for this OKAP examination, a three-hour board review series is conducted prior to the exam.

Residents are encouraged to initiate and complete research projects in either the clinical or basic sciences. Numerous abstracts, presentations, and manuscripts are generated annually and accepted in peer-reviewed journals. Cases are presented half-quarterly at Cornea and Refractive Surgery Service rounds and at departmental grand rounds. The Cornea Service sponsors a series of lectures throughout the academic year covering all areas of the specialty. In addition, there is a monthly OKAP board review series. Case presentations are presented monthly at Cornea and Refractive Surgery Service Rounds and quarterly at departmental grand rounds. A schedule of these lectures can be obtained through the Resident Education office.

Uveitis Resident Training

First- and Second-year residents are taught the methodical approach to the uveitis patient. History-taking skills, review of systems, and physical examination are critical in establishing a targeted diagnostic workup. Specific management of infectious etiologies, such as acute retinal necrosis, ocular syphilis, and toxoplasmosis, are learned. Additionally, the resident learns about the management of chronic noninfectious inflammatory disease, including the appropriate use of regional and systemic steroids and, in close conjunction with rheumatologists, the indication and treatment with systemic immunosuppressives, such as methotrexate, adalimumab, and cyclophosphamide.

Senior residents learn the perioperative stabilization of the uveitis patient who will undergo cataract and intraocular surgery. Seniors also learn the intraoperative management of uveitis patients, including anterior and posterior synechiolysis, iris hooks, and intraocular lens choice. Senior residents gain an understanding of the indications for endolaser, pars plana vitrectomy/vitreous biopsy, and chorioretinal biopsy in these patients.

A very important aspect of surgical training at the New York Eye and Ear Infirmary of Mount Sinai is the Jorge N. Buxton Microsurgical Lab. Residents have 24-hour access to the microsurgical lab which is equipped with microscopes, surgical instruments, and practice eyes. Residents also have the opportunity to use the Eyesi surgical simulator for practicing cataract surgery and vitrectomy. Surgical education is further enhanced by hands-on microsurgical wet lab courses for each subspecialty lead by dedicated faculty.

Program Conferences and Lectures

Didactic education for the residents is formalized with lectures, conferences, courses, and grand rounds. An overview of the educational activities offered to residents includes:

OKAP and Board Review Course, held in January and February of each year

Option to attend both the New York Eye and Ear Infirmary and the Massachusetts Eye and Ear Infirmary cataract course

Refractive surgery lectures and courses with the ability to become certified

Ophthalmology Resident Research

All residents are required to work on a meaningful research project over the course of their residency and present their work at the Annual NYEE Resident Research Day. To facilitate this, residents have dedicated research time in first and second year. Financial support is given for travel to meetings in the continental US for the purpose of presenting research. The Department of Ophthalmology also offers grants and other funding to support resident research.